Concord Monitor (N.H.)
Sept. 9, 2016

Last week, in Nashua, the mother of 3-year-old Brielle Gage was found guilty of beating her to death. In Manchester, another mother stands accused of killing her 21-month-old daughter, Sadie Willott, who died of blunt impact head injuries. The state’s Division for Children, Youth and Families, charged with protecting children from abuse and neglect, had been involved with both families. Yet, two helpless little girls are gone. Why?

In the aftermath, Gov. Maggie Hassan and the Executive Council committed $223,000 – $96,000 of that in general funds – for a nationally known consulting firm, the Center for the Support of Families, to conduct an independent review of DCYF practices. Since April, the review team has held face-to-face interviews with state child protection workers, court-appointed guardians, foster parents and juveniles in the system. They have pulled 100 DCYF case files at random for review and sent surveys to educators, health care providers, parents and guardians. They were scheduled to meet with the police in Manchester and Nashua to talk about the Willott and Gage cases, and more broadly about DCYF.

The strict confidentiality rules on abuse and neglect cases protect young victims, but that secrecy runs head on into the public’s justifiable demand for more transparency at DCYF. The outside review is a good response, but temporary. Lawmakers should give serious consideration to a proposal for a new Office of the Child Advocate – used successfully in Massachusetts – which would have independent authority to review the child protection system, and enhance public confidence in DCYF.

The state Supreme Court last month opened the door, a crack, on the confidentiality issue, when it cleared the way for public filing of a civil lawsuit against DCYF and others. Details of the child sexual abuse and neglect case underlying the lawsuit must remain confidential, the court said, but the claims of alleged failures by child protective services – including DCYF – can be part of the public record.

Meanwhile, we hope the ongoing outside review generates some honest, independent feedback, especially from the many child-protection workers at DCYF, who are working hard at a very difficult job. We trust the independent review process is far enough away from the governor’s office, and from the Department of Health and Human Services, of which DCYF is a part, to get at the facts, and the truth, whatever that may be.

Most importantly, we expect the reviewers to address the heart of the matter, which DCYF director, Lorraine Bartlett identified in a report in January. New assignments for New Hampshire child protection workers exceed the standard in 20 other states, Bartlett said. She has cited a 17 percent increase in protective investigations in four years, but no increase in staff. Unmanageable caseloads impact child safety, lead to burnout, “decision fatigue” and high staff turnover, which reached 50 percent from 2013-15, she wrote.

“High turnover has significant impact on the agency’s ability to effectively manage the work and caseload, and ultimately sustain best outcomes for children and families,” she said.

The independent review team’s final report is expected before their contract expires on Dec. 31. By that time, Gov. Hassan, who is running for the U.S. Senate, will be on her way out of the State House and a new governor – and Legislature – will be responsible for acting on the review’s findings.

In Tuesday’s primary election, voters will select the Republican and Democratic candidates for the corner office. You don’t need to wait for a report to ask the candidates how they plan to protect New Hampshire’s children from abuse, and neglect, and murder. Find out now for Brielle and Sadie and for the sake of all the other children in this state whose safety is threatened– by their own parents.

Cape Cod Times (Mass.)
Sept. 10, 2016

Almost everyone who needs a prescription medicine has at one point or another experienced the sense of sticker shock that comes with a new script, especially if the particular medication does not have a generic equivalent. The patient is then faced with the quandary of declining medical care or finding a way to pay for it, regardless of the cost.

So when people who rely on EpiPens, the preferred delivery system of a medication designed to stave off potentially life-threatening anaphylactic reactions, saw the price skyrocket during the past few years, it likely came as little surprise. In fact, what may be most surprising is that the question of cost quickly became a political issue, with even presidential hopefuls weighing in on the matter.

The jump in EpiPen costs has been spread over nine years, with the two-pack price leapfrogging from $100 to $600 during that time. According to at least one medical professional, the active drug, the generic epinephrine, is relatively inexpensive. In fact, one Cape Cod Hospital employee put the price of an injection at less than $5.

Instead, it is the convenient delivery method that patients are paying for. The pharmaceutical company Mylan owns the patent on the EpiPen system, and can basically charge whatever it wants for it, doing so in the full knowledge that patients and their insurance companies have little choice but to pony up, regardless of how exorbitant the price may be.

For its part, Mylan has deferred blame to the overall health care system with an amorphous charge that insurance companies have, in essence, shifted the costs of medications onto their patients. It simultaneously began a public relations volley to staunch criticism, announcing a coupon to cover up to $300 of the drug’s out-of-pocket cost, as well as a plan to expand a patient assistance program that helps eliminate such costs for uninsured and under-insured patients. It is also providing free pens to schools.

All of this is, of course, good news for patients and school systems across the Cape and beyond. It does not, however, address the underlying question of how a delivery system that was developed years ago now costs six times as much as it did less than a decade ago. If anything, one would expect Mylan to develop economies of scale and production that would hold down, if not lower, costs.

Then there was news this past week from the New York Times that even as Mylan was directly gouging customers, it was also emptying their pockets indirectly through a questionable claim that because epinephrine is a generic drug, it can only offer a reduced discount to state Medicaid programs. In essence, the company is trying to enjoy the benefits of an exclusive product that has no viable competition in the marketplace, all while maintaining with a straight face that it cannot possibly offer any substantive deal to state-run programs because it is a generic drug.

The revelation has prompted several lawmakers to call for a wider investigation to determine if Medicaid is being fleeced by other drug manufacturers seeking to expand profits at the expense of taxpayers.

At the same time, public anger over the moves by Mylan to shore up its profits continues to grow, even as the company, under the guidance of CEO Heather Bresch, continues to maintain it has done nothing wrong. In fact, it recently announced that it intends to introduce a generic version of the EpiPen for $300. In the press release announcing the move, Bresch was quoted as saying that “ensuring access to medicine is absolutely the core of Mylan’s mission and has been since our founding 55 years ago.”

This is the sort of generic pharmaceutical industry palaver that demonstrates that there is no monopoly when it comes to spouting empty platitudes, even as stockholders smile over growing dividends. Politicians and the public should therefore look toward new restrictions on an industry that seems quite comfortable jettisoning the Hippocratic Oath for one that embraces hypocrisy instead.